- Enrollment id
- O20170615002115
- Enrollment state
- NY
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1871948299
- Multiple npi flag
- N
- Ccn
- 335804
- Associate id
- 8224306220
- Organization name
- KENNEDY PAVILION RH LLC
- Doing business as name
- THE PAVILLION AT QUEENS FOR REHABILITATION & NURSING
- Incorporation date
- 2015-11-03
- Incorporation state
- NY
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- THE PAVILION AT QUEENS FOR REHABILITATION & NURSING
- Address line 1
- 3617 PARSONS BLVD
- City
- FLUSHING
- State
- NY
- Zip code
- 113545931